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The use of electronic patient-reported outcomes has increased recently, and smartphones offer distinct advantages over other devices. However, previous systematic reviews have not investigated the reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Kessler Screening Scale for Psychological Distress (K6) when used with smartphones, and this has not been fully explored. This study aimed to evaluate the equivalence of the paper and smartphone versions of the CES-D, GAD-7, and K6, which were compared following a randomized crossover design method in 100 adults in Gunma, Japan. Participants responded to the paper and smartphone versions at 1-week intervals. The equivalence of paper and smartphone versions was evaluated using the intraclass correlation coefficient (ICCagreement). The mean participant age was 19.86 years (SD = 1.08, 23% male). The ICCagreements for the paper and smartphone versions of the CES-D, GAD-7, and K6 were 0.76 (95% confidence interval [CI] 0.66–0.83), 0.68 (95% CI 0.59–0.77), and 0.83 (95% CI 0.75–0.88), respectively. Thus, the CES-D and K6 scales are appropriate for use in a smartphone version, which could be applied to clinical and research settings in which the paper or smartphone versions could be used as needed.

Objectives The purpose of the study was to examine the immediate-term effect of positive-word stimuli via a smartphone application on the multi-directional reach ability in standing position in young adults. Methods This study was an immediate-term, assessor-blinded, two-arm, parallel-group, randomized controlled trial among young adults recruited from one university in Japan. Participants were randomly assigned to the experimental group or control group using a computer-based random number-generating programme. Participants of the experimental group used an application on iPhone and watched 3-min videos displaying positive-word stimuli. This application repeatedly displayed positive-word stimuli every 5 s. The participants of the control group used an application on iPhone and watched the same videos as in the experimental group. However, a positive-word stimulus did not appear in the videos. The primary outcome was the multi-directional reach test (MDRT) from baseline to immediately after the intervention protocol. Results Among the 62 randomized participants (experimental group, n = 31; control group, n = 31), 62 (100%) completed the MDRT immediately after the intervention protocol. There were no differences in mean group change values in MDRT between the experimental and control groups. Conclusions Among young adults, positive-word stimuli via a smartphone application did not significantly improve multi-directional reach ability in standing position. These findings do not support the superiority of this intervention among young adults. Trial Registration: Clinicaltrials.gov, NCT03546218. Registered 6 June 2018, https://clinicaltrials.gov/ct2/show/NCT03546218KEY MESSAGESIn our study, among young adults, positive-word stimuli via an SPSRS application did not significantly improve the multi-directional reach ability in the standing position.These findings do not support the superiority of this intervention among young adults.

The purpose of this study was to compare prefrontal cortex (PFC) activity among subjects with differing social anxiety (SA) severity levels to identify a possible biomarker for severe SA. Further, SA is generally under-diagnosed, so we examined if such measurements could be acquired conveniently, non-invasively, and at low cost using a portable near-infrared spectroscopy (NIRS) system. We classified 96 participants into three groups based on Liebowitz Social Anxiety Scale (LSAS) total score: Low SA (LSA, n = 40), Moderate SA (MSA, n = 39), and High SA (HSA, n = 17). We compared the prefrontal hemodynamic responses among LSAS severity groups during a verbal fluency task using a palm-sized NIRS system. The HSA group exhibited a significantly lower hemodynamic response in the left PFC compared to LSA and MSA groups, whereas there was no significant difference between LSA and MSA groups. There was also no significant difference in the right PFC hemodynamic response among groups. Differences in the severity of SA symptoms may be related to the left PFC function. Low PFC activity during specific cognitive tasks may provide a biomarker for distinguishing severe from mild/moderate SA symptoms to guide subsequent therapeutic decisions.

Hitomi Ejiri, 1 Hiroyuki Uchida, 2 Kenji Tsuchiya, 1, 3 Kazuhiko Fujiwara, 4 Senichiro Kikuchi, 1, 3 Kazuki Hirao 1, 3 1School of Health Sciences, Faculty of Medicine, Gunma University, Maebashi, Japan; 2Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan; 3Graduate School of Health Sciences, Gunma University, Maebashi, Japan; 4Department of Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Nishikyusyu University, Kanzaki, JapanCorrespondence: Kazuki HiraoGraduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma, 371-8514, JapanTel/Fax +81-27-220-8952Email kazuki.hirao@gunma-u.ac.jpBackground: Major depressive disorder (MDD) is an important public health problem. Thus, preventive interventions against subthreshold depression (StD), which is one of the key risk factors for the development of MDD, are important. The study developed a smartphone application (SPSRS) that improves depressive symptoms in people with StD by automatically presenting positive word stimuli during videos. The SPSRS application has the potential to improve depressive symptoms in people with StDs. However, whether it can immediately improve depressed moods in people with StD is unclear. The study presents a protocol for investigating the immediate effects of the SPSRS application intervention on depressed mood in people with StD.Methods: The study is designed as an open-label, parallel-group, and pilot randomized controlled trial (RCT). Thirty-two people who meet the criteria for StD (Beck Depression Inventory-II score of 10 points or more and fails to meet the diagnostic criteria for MDD) will be recruited and studied. It compares the immediate effects of the SPSRS application intervention (with positive word stimulus in a 10-minute video; n = 16) and YouTube application intervention (without positive word stimulus in 10-minute video; n = 16). The primary outcome is the change in the score for the Profile of Mood States 2nd Edition-Adult Short after 10 minutes of intervention. The secondary outcome is the change in the State–Trait Anxiety Inventory State after 10 min of intervention.Discussion: The pilot RCT is the first to evaluate the immediate effects of the SPSRS application intervention on depressed mood in people with StD. The results are expected to provide a preliminary outcome of the immediate effect of the SPSRS application on the depressed mood of people with StD and aid in planning a full-scale trial.Trial Registration: ClinicalTrials.gov; Identifier: NCT03864484.Keywords: depression, subthreshold depression, depressed mood, mobile application, smartphoneCorrigendum for this paper has been published

Objective: To verify the effect of adjusting the challenge–skill balance with respect to rehabilitation process. Design: A single-blind, two-arm, parallel-group, randomized controlled trial. Setting: Recovery rehabilitation unit of Harue Hospital, Japan. Subjects: The trial included 72 clients (mean (SD): age, 74.64 (9.51) years; Functional Independence Measure score, 98.26 (15.27)) with cerebral or spinal disease or musculoskeletal disease. Interventions: Clients were randomly divided into two groups: the experimental group, who received occupational therapy with adjustment of the challenge–skill balance, and the control group who received conventional occupational therapy. Time from admission to discharge was considered the implementation period; the final evaluation was conducted at three months after discharge. Main measures: The primary outcome was subjective quality of life (Ikigai-9). Secondary outcomes were the health-related quality of life (EuroQol–5 Dimensions, Five Levels (EQ-5D-5L)), the Flow State Scale for Occupational Tasks, and the Functional Independence Measure. A cost-effectiveness analysis was conducted using total cost and quality-adjusted life-year based on the EQ-5D-5L. Results: Significant differences were observed between the experimental and control groups with respect to the Ikigai-9 score ( P = 0.008) and EQ-5D-5L ( P = 0.038), and the effect sizes were 0.76 (95% confidence interval [CI]: 0.27–1.24) and 0.62 (95% CI: 0.14–1.10), respectively. No significant between-group differences in other outcomes were observed, for example, the Functional Independence Measure score improved in both experimental and control groups (119.80 (5.50) and 118.84 (6.97), respectively. The incremental cost-effectiveness ratio was US$5518.38. Conclusions: Adjusting the challenge–skill balance may be a useful approach to improve the participant’s subjective quality of life in the rehabilitation process.

首都大学東京学位論文甲第967号副論文

Introduction: Interventions aimed at addressing subthreshold depression (StD) are important to prevent the onset of major depressive disorder. Our video playback application (SPSRS) is designed to reduce depressive symptoms by presenting positive words in videos, shedding new light on the treatment of StD. However, no randomized controlled trial (RCT) has utilized this video playback application for the treatment of individuals with StD. Therefore, a pilot RCT was designed to determine the feasibility of a full-scale trial. We herein present a study protocol for investigating the utility of a video playback application intervention for individuals with StD. Methods: This 5-week, single-blind, 2-arm, parallel-group, pilot RCT will determine the effectiveness of the video playback application by comparing individuals who had and had not been exposed to the same. A total of 32 individuals with StD will be randomly assigned to the experimental or control group at a 1:1 ratio. The experimental group will receive a 10-minute intervention containing the video playback application per day, whereas the control group will receive no intervention. The primary outcome will include changes in the Center for Epidemiologic Studies Depression Scale score after the 5-week intervention, while secondary outcomes will include changes in the Kessler Screening Scale for psychological distress and the generalized anxiety disorder 7-item scale score after the 5-week intervention. Statistical analysis using linear mixed models with the restricted maximum likelihood estimation method will then be performed. Discussion: This pilot RCT will have been the first to explore the utility of SPSRS application interventions that display positive words in videos for individuals with StD. The results of this pilot trial are expected to help in the design and implementation of a full-scale RCT that investigates the effects of SPSRS applications among individuals with StD. Trial registration: ClinicalTrials.gov Identifier: NCT04136041

Developing support and an environment for patients with dementia in hospitals is important. This study aims to assess the immediate effect of one-session cognitive stimulation intervention on the mood of patients with dementia in a hospital as preliminary evidence. This study included 33 female patients. The cognitive stimulation intervention was conducted in the day room of the hospital ward by two occupational therapists. The patients participated in one or more sessions. The cognitive stimulation intervention was designed to discuss current affairs that implicitly stimulate memory, executive function, and language skills, according to the cognitive stimulation definition. Outcomes were evaluated using a two-dimensional mood scale. The primary outcome was pleasure. The before and after session scores for the first session and the average score before and after each session at multiple times were compared. The patients’ pleasure showed significant improvements in both analyses. These results may indicate that one-session Cognitive stimulation intervention in a hospital effectively improves a mood of pleasure immediately. This study is the first report to provide preliminary evidence on the beneficial alterations of mood after one-session cognitive stimulation intervention for patients with dementia in hospitals. Cognitive stimulation intervention may be an effective non-pharmacotherapy for these patients.

Background Anxiety disorder is a major societal, economic, and healthcare burden, so it is essential to identify underlying risk factors. Sense of coherence (SOC), defined as an individual's perceived ability to control events and cope with challenges, is strongly associated with healthcare outcomes. Methods This study investigated the association between SOC and anxiety among adults in all 47 prefectures of Japan using a cross-sectional online panel survey. SOC was assessed using the University of Tokyo Health Sociology version of the SOC Scale and anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. Results Among 2100 participants (1051 males and 1049 females), 475 (22.6%) were identified with anxiety (scoring 8 points or higher on the GAD-7 scale). Before adjustment for potential confounders, there was a significant negative association between SOC and presence of anxiety. Even after adjustment, the presence of anxiety was significantly higher among the lower SOC subgroup than the higher SOC subgroup. Conclusions These results indicate that approximately one-fifth of adults in Japan suffer from anxiety and that low SOC is a significant risk factor.

Objective: Although the self-report version of Liebowitz Social Anxiety Scale (LSAS) is frequently used to measure social anxiety, data is lacking on the smallest detectable change (SDC), an important index of measurement error. We therefore aimed to determine the SDC of LSAS. Methods: Japanese adults aged 20-69 years were invited from a panel managed by a nationwide internet research agency. We then conducted a test-retest internet survey with a two-week interval to estimate the SDC at the individual (SDCind) and group (SDCgroup) levels. Results: The analysis included 1300 participants. The SDCind and SDCgroup for the total fear subscale (scoring range: 0-72) were 23.52 points (32.7%) and 0.65 points (0.9%), respectively. The SDCind and SDCgroup for the total avoidance subscale (scoring range: 0-72) were 32.43 points (45.0%) and 0.90 points (1.2%), respectively. The SDCind and SDCgroup for the overall total score (scoring range: 0-144) were 45.90 points (31.9%) and 1.27 points (0.9%), respectively. Conclusions: Measurement error is large and indicate the potential for major problems when attempting to use the LSAS to detect changes at the individual level. These results should be considered when using the LSAS as measures of treatment change.

Aim We developed a motion picture-reproducing smartphone application (app) designed to improve self-confidence in individuals with subthreshold depression (StD) and examined the feasibility and preliminary efficacy of an app intervention for individuals with StD. Methods We conducted an open-label, single-arm pre-post study of 22 young adults with StD. Our intervention involved app usage for at least 70 min/wk for 5 weeks. The primary outcome measure was the adherence rate. Secondary outcome measures were safety and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Results No participants dropped out during the study. The adherence rate was 50%. The mean time of app use over 5 weeks was 124.23 ± 81.94 min/wk. No adverse events were reported. The CES-D scores were significantly improved at 5 weeks post-intervention. Conclusions Although this app intervention has the potential to reduce depressive symptoms, the app needs to be improved to increase adherence rates.

Background Subthreshold depression (StD) is more common than major depressive disorder. Objective The study aimed to identify common words to improve self-confidence in Japanese university students with StD for developing a smartphone application to help those with StD. Methods In this cross-sectional study, words participants used to improve their self-confidence were gathered using self-report questionnaires in 154 university students in Japan. The words used to improve self-confidence were categorized using a computerized text analysis method based on the frequency of appearance. Results Participants were 154 male and females [StD group (n = 82) and healthy control (HC) group (n = 72); median age = 20 years]. A total of 290 words for improving self-confidence were identified. In the StD group, the keywords that appeared with the highest frequencies were “can”, “let’s try”, “good luck”, “able”, and “don’t worry”. The keywords that occurred with the highest frequencies (the top eight) were common across both groups. The keywords were grouped into eight categories. The “encouragement” and “praise” categories were found in the responses of more than 80% of participants in both groups. Frequencies of the “determination” and “trust” categories were significantly higher in the StD group than in the HC group. Conclusions We conclude that “can”, “let’s try”, and “good luck” are the most common words that Japanese students with StD use when describing how they improve their self-confidence. Future work will use these common words to develop a smartphone application to help those suffering from StD.

Although self-efficacy has been used extensively in the field of nursing (e.g., as an outcome measure of nursing interventions), its underlying nature is poorly understood. Investigation of the relationship between self-efficacy and brain activation will help explain the fundamental nature of self-efficacy. In this study, we compared prefrontal activation measured with near-infrared spectroscopy (NIRS) across 89 undergraduate students categorized into three groups based on their General Self-Efficacy Scale scores: low self-efficacy ( n = 59), moderate self-efficacy ( n = 17), and high self-efficacy ( n = 13). Changes in the hemoglobin levels of the prefrontal cortex (PFC) during a verbal fluency task were assessed using two-channel NIRS. Significant differences in the oxygenated hemoglobin (oxy-Hb) level of the left PFC (LPFC) were observed via analysis of variance. Post hoc Tukey’s test showed a significant difference only between low self-efficacy and moderate self-efficacy groups. We found a medium between-group effect size in the moderate self-efficacy group versus the low self-efficacy group for the changes in oxy-Hb levels of the LPFC ( d = .78; 95% confidence interval for effect size [0.22, 1.33]). No significant between-group differences were observed with respect to changes in the oxy-Hb in the right PFC. The results indicate less left prefrontal activation in the low self-efficacy group than in the moderate self-efficacy group. These findings provide evidence to support the fundamental nature of self-efficacy.

Rationale, aims, and objectives This study aims to examine the smallest detectable change (SDC) and test-retest reliability of the Center for Epidemiological Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and 12-item General Health Questionnaire (GHQ-12). Method We tested 154 young adults at baseline and 2 weeks later. We calculated the intra-class correlation coefficients (ICCs) for test-retest reliability with a two-way random effects model for agreement. We then calculated the standard error of measurement (SEM) for agreement using the ICC formula. The SEM for agreement was used to calculate SDC values at the individual level (SDCind) and group level (SDCgroup). Results The study participants included 137 young adults. The ICCs for all self-reported outcome measurement scales exceeded 0.70. The SEM of CES-D was 3.64, leading to an SDCind of 10.10 points and SDCgroup of 0.86 points. The SEM of GSES was 1.56, leading to an SDCind of 4.33 points and SDCgroup of 0.37 points. The SEM of GHQ-12 with bimodal scoring was 1.47, leading to an SDCind of 4.06 points and SDCgroup of 0.35 points. The SEM of GHQ-12 with Likert scoring was 2.44, leading to an SDCind of 6.76 points and SDCgroup of 0.58 points. Conclusion To confirm that the change was not a result of measurement error, a score of self-reported outcome measurement scales would need to change by an amount greater than these SDC values. This has important implications for clinicians and epidemiologists when assessing outcomes.

Background: Flow experience is thought to enhance health-related quality of life by mitigating stress and providing a sense of achievement. The associations between flow experience and subclinical psychiatric anomalies, such as schizotypal personality traits and paranoid ideation, have not been examined. Objectives: This study aimed to evaluate the associations between flow experience and subclinical psychiatric anomalies in a healthy population. Materials and Methods: This cross-sectional study included 64 undergraduates from Kibi international university, Japan (42 males, 22 females; mean age 20.1 ± 1.13 years). Schizotypal personality was measured using the Japanese version of the Oxford Schizotypal Personality Scale (STA). Paranoia was measured using the Japanese-version Paranoia Checklist (JPC). Flow experience was measured using the Flow Experience Checklist (FEC). Results: Both the STA score and the JPC distress subscore were positively correlated with the FEC score. However, no correlation was observed between either the JPC conviction or the frequency subscore and the FEC score. Stepwise multiple regression analysis revealed that the FEC score was influenced only by the STA score. Conclusions: Schizotypal personality traits appear to enhance the quality of flow experiences, but not their frequency or duration. We suggest that these intense flow experiences serve as a distraction from psychological abnormalities, such as paranoid ideation.

This study was performed to investigate the relationship between mental state (especially flow experience [Flow Experience Checklist of Ishimura]) health-related quality of life (Medical Outcome Study 8-Item Short-Form Health Survey), and stress (salivary amylase concentrations). The subjects were 119 healthy elderly persons living in rural areas who participated in a "meeting for the elderly" at a nursing home in Kagawa Prefecture, Japan. The subjects were classified into apathetic, anxious, relaxed, and flow groups. It was found that physical health was significantly better when performing important daily activities in the group who experienced flow and the relaxed group than in the group that was in an apathetic state. However, no significant relationship was observed between the degree of flow experience and stress. The present findings suggested that interventions which make the activities of daily life either "high-challenge, high-skill" situations or "low-challenge, high-skill" situations could have a positive influence on the physical health of community-living elderly Japanese. A longitudinal study should be performed in the future.

IntroductionOccupational therapy (OT) is defined as the promotion of client health and well-being through a client-centred practice. However, there is a tendency to rely on the therapist’s experiences and values, and there is a difference between the client’s and therapist’s perceptions regarding the current activity that the client is engaged in. In previous studies that have applied ‘flow’, activities supported by OT in elderly people were analysed, indicating a difference in recognition. Therefore, we thought that more effective OT could be implemented by adjusting the challenge–skill (ACS) balance, and we invented a novel process termed as ACS balance for OT. The purpose of this study is to verify the effect of ACS-OT on clients in the recovery rehabilitation unit and to prepare a protocol for randomised controlled trial (RCT) implementation.Method and analysisThis single-blind RCT will recruit 80 clients aged 50–99 years admitted to the recovery rehabilitation unit who meet eligibility criteria. Clients will be randomly allocated to receive ACS-OT or standard OT. Both interventions will be performed during the clients’ residence at the unit. The primary outcome measure will be subjective quality of life and will be measured at entry into (pre) and at discharge from (post) the unit and at 3 months afterwards (follow-up). Outcomes will be analysed using a linear mixed model fitted with a maximum likelihood estimation.Ethics and disseminationThis protocol has been approved by the ethics review committee of the Tokyo Metropolitan University (No.17020). Results of this trial will be submitted for publication in a peer-reviewed journal.Trial registration numberUMIN-CTR number, UMIN000029505; Pre-results.

OBJECTIVE. We sought to investigate whether occupational therapy that includes adjusting the challenge–skill balance improves health-related quality of life (HRQOL) for older adults in comparison with standard occupational therapy. METHOD. In this single-blind, randomized controlled trial, 56 older adults were assigned to two groups that received 10 sessions of occupational therapy with and without adjustment of challenge–skill balance. The primary outcome was change in HRQOL after 10 sessions of occupational therapy. RESULTS. Significant differences were observed in HRQOL using the EuroQol–5 Dimension score (p = .022, d = 0.76) and the eight-item Short-Form Health Survey scores for general health (p = .001, d = 0.99) and in flow experience using the Flow State Scale for Occupational Tasks (p = .008, d = 0.82). CONCLUSION. Assessment and adjustment of the challenge–skill balance of activities may effectively improve older adults’ HRQOL.

We studied intermediate-band solar cells (IBSCs) incorporating highly homogeneous InAs/GaAs quantum dot superlattices (QDSLs). The extra photocurrent generated by two-step photon absorption markedly increases at the fundamental state (FS) because the FS miniband has been successfully formed in the QDSL-IBSC by controlling the QD size homogeneity. Here, the carriers excited into the miniband spatially separate in the internal electric field, and the long-lived electrons in the intermediate states of the miniband increase the inter-subband absorption strength. The two-step photocurrent response, therefore, extends toward the longer-wavelength side corresponding to the QDSL-FS at approximately 1.2 µm.

We studied the effects of miniband formation on the photocurrent generated by two-step intersubband absorption in an intermediate-band solar cell incorporating an InAs/GaAs quantum dot superlattice (QDSL). The two-step photocarrier generation increases with the electronic state coupling of InAs QDSLs in the intrinsic layer. Because carriers that are excited into the superlattice minibands spatially separate in an internal electric field, the electron-hole recombination rate for the photoexcited carriers decreases, and therefore, the electron lifetime increases. The long-lived electrons in the intermediate states of the QDSL miniband increase the intersubband absorption strength. We confirmed a systematic sensitive change in the two-step photocurrent generation depending on the miniband formation controlled by the temperature.

Kazuki Hirao, Ryuji Kobayashi, Kenji YabuwakiDepartment of Occupational Therapy, School of Health Science and Social Welfare, Kibi International University, Takahashi City, Okayama, JapanObjective: To determine the association of cognitive judgment and shyness with frequency and quality of flow experience.Design and methods: This was a cross-sectional survey of the relationship between psychological tendency and frequency and quality of flow experience in 68 college students, undertaken in Hiroshima, Japan. The predictors were Shyness Scale scores, measure of ambiguity tolerance scores, and Life Orientation Test scores, and the outcome was the frequency and quality of flow experience.Results: The results of the binary logistic regression analysis indicated that only the measure of ambiguity tolerance (P = 0.02, odds ratio = 1.06, and 95% confidence interval = 1.01–1.11) was a predictor of the quality of flow experience, and only the Shyness Scale (P = 0.007, odds ratio = 0.95, and 95% confidence interval = 0.91–0.98) was a predictor of the frequency of flow experience.Conclusion: The findings suggest that ambiguity tolerance and shyness are associated with the frequency and quality of the flow experience.Keywords: Flow experience, positive psychology, shyness, ambiguity tolerance, life orientation

In order to achieve increase of power outputs of an ABWR, it is extremely important to evaluate coolant flow in a lower plenum. Numerical simulation is helpful to predict the coolant flow, and thus verification experiments are needed. Hence, the present study is focusing on the construction of benchmark of CFD code. The objective of the study is to clarify relation between flow distribution to the core and the complicated flow structures in the lower plenum. We constructed a 1/10 model of a lower plenum to conduct flow experiment for validation of CFD analysis. In the experiment, it turned out that coolant flow distribution becomes to be uniform at core support beam, and there are complicated flows like vortices around side entry orifices. Regarding differential pressure distribution, it was revealed that profile of the region including side entry orifices is very dominant. This pressure loss might be caused by contraction flow at the orifices. Such flow structures were also described by CFD analysis. As good performance of analysis, we investigated flow distribution to the core particularly by using CFD results. And relation between the flow distribution and the complicated flow structures were also discussed.

This study was performed to investigate the relationship between mental state (especially flow experience [Flow Experience Checklist of Ishimura]) health-related quality of life (Medical Outcome Study 8-Item Short-Form Health Survey), and stress (salivary amylase concentrations). The subjects were 119 healthy elderly persons living in rural areas who participated in a "meeting for the elderly" at a nursing home in Kagawa Prefecture, Japan. The subjects were classified into apathetic, anxious, relaxed, and flow groups. It was found that physical health was significantly better when performing important daily activities in the group who experienced flow and the relaxed group than in the group that was in an apathetic state. However, no significant relationship was observed between the degree of flow experience and stress. The present findings suggested that interventions which make the activities of daily life either "high-challenge, high-skill" situations or "low-challenge, high-skill" situations could have a positive influence on the physical health of community-living elderly Japanese. A longitudinal study should be performed in the future.

Background: Autotelic personality (AP) is known to have a positive effect on the quality of life. We hypothesized that inferiority feelings may be less pronounced in individuals with AP than in those with an average (AV) or a nonautotelic personality (NAP). Aims: This study aimed to compare inferiority feelings among three personality groups: An AP group, an AV group, and an NAP group. Materials and Methods: This study was a cross-sectional survey among 148 undergraduate students aged 18-24 undertaken in Okayama, Japan. Participants completed the Flow Experience Checklist and Inferiority Feelings Scale. Results: With the number of flow activities, participants were classified into three groups: 3+ for AP ( n = 28, 18.9%), 1-2 for AV ( n = 72, 48.6%), and 0 for NAP ( n = 48, 32.4%). One-way analysis of variance showed significant differences among the three groups with respect to the Inferiority Feelings Scale. Multiple comparison analysis using Tukey's test showed that inferiority feelings in AP were significantly less pronounced than in the NAP group. Conclusion: The results of this study indicated that AP was lesser than NAP in association with pronounced inferiority feelings.

Kazuki Hirao, Ryuji Kobayashi Department of Occupational Therapy, School of Health Science and Social Welfare, Kibi International University, Okayama, Japan Purpose: To determine the relationship between self-disgust, guilt, and flow experience. Methods: A cross-sectional survey was conducted in a convenience sample of 142 Kibi International University students (mean age, 20.09 ± 1.24 years; 85 males and 57 females). Each participant was evaluated using the Flow Experience Checklist, Self-Disgust Scale, and Situational Guilt Inventory. Correlation analysis was used to describe the strength and direction of the relationship between variables. We employed Pearson's partial correlations, adjusted for age and sex, using dummy variables (female = 0, male = 1). Results: Analysis of the relationship between the frequency of flow experience and the Self-Disgust Scale scores showed a statistically significant negative correlation, whereas the duration of the activity and the Situational Guilt Inventory score showed a significant positive correlation. The quality of flow experience and the Situational Guilt Inventory score showed a significant positive correlation. Conclusion: These findings suggest that flow experience could be helpful for those who need treatment to reduce negative emotions. Keywords: negative emotion, mental health, positive psychology

Background: Internet addiction (IA) is a common disorder among adolescents throughout most of the industrialized world. The purpose of this study was to compare mental states between Japanese undergraduates with IA and those without IA. Methods: In a cross-sectional survey, 165 healthy participants were assessed for IA using the Internet Addiction Test (IAT), for the frequency and quality of flow experiences in daily life using the Flow Experience Checklist (FEC), and for depressive symptoms using the Patient Health Questionnaire (PHQ-9), Beck Depression Inventory-II (BDI-II), and Zung Self-Rating Depression Scale (SDS). Results: The results showed that the prevalence of IA in the participants of this study was 15% and the frequencies of flow experience and depressive symptoms were significantly higher in the IA group. Conclusion: The results indicate that IA affects a significant number of Japanese university students and is associated with higher rates of depressive symptoms, suggesting a need for intervention programs as part of student mental health services.